NPI 1003186073

Ellsworth P Gast

Practitioner Pharmacist Green Bay, WI

Practice location

Address: 1995 Main St, Green Bay, WI 54302-3920
Phone: (920) 465-6210
Mailing address: 2843 Newberry Ave, Green Bay, WI 54302-5214

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 7587-040 (WI)

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Registry record

NPI: 1003186073
Entity type: Individual
Sex (as registered): Male
NPI issued: 9 Jan 2012
Record last updated: 9 Jan 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.